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Britt Berrett, president of Texas Health Presbyterian Hospital Dallas and executive vice president of Texas Health Resources, says that "the name of the game now is outside the walls of this hospital."

Under the fee-for-service model, there has been little incentive for the hospital to manage postdischarge medication reconciliation or navigation, but that is changing. "We [are] forced to do something we should have been doing in the past. We have an obligation to identify what the needs are, where before we just didn't worry about it."

Van Gorder says that to succeed, hospitals must recognize that the shift to population health changes more than just a business model; it also creates a new relationship with patients.

"I asked my people the other day, 'What is it we really sell? Is it healthcare?' I said we sell relationships, and yet we really haven't cared much about the relationships." Van Gorder remembers his own experience as a patient in a gatekeeper health maintenance organization, where he had to sign up for a primary care doctor and never heard from that physician again.

"So, I think, for the time first ever, we're going to have to actually build an ambulatory relationship with our patients," he says, "and then find out what their needs are and find a way of meeting those needs to keep them healthy."

Reprint HLR0213-11

This article appears in the January/February 2013 issue of HealthLeaders magazine.